Small Bowel Procedures

Procedure Details

Double-Balloon Enteroscopy

The small bowel is approximately 20 feet in length and has historically been an inaccessible part of the gastrointestinal tract.
With the advent of balloon-assisted enteroscopy much of the small bowel can now be reached allowing for both examination and the ability to perform endoscopic interventions. These interventions include tissue sampling, control of bleeding, dilation of strictures, removal of polyps or extraction of foreign bodies. In some instances this procedure can allow patients to avoid surgery on the small bowel.
Balloon-assisted or deep enteroscopy can be performed in an outpatient or inpatient setting and may require several hours, depending on the therapy required. Most procedures are performed through the mouth (antegrade), although the retrograde approach (through the rectum), may allow better access to lesions in the lower part of the small bowel.

PEG-J (Percutaneous Endoscopic Gastrostomy with Jejunal Extension)

This endoscopic technique allows for the placement of a feeding tube into the stomach through the skin. During the procedure the endoscope is advanced through the mouth and into the stomach which is then insufflated with gas. This allows for direct contact of the stomach with the abdominal wall. The abdominal and stomach walls are then punctured with a needle and the feeding tube is inserted under direct visualization.
Next, a longer scope is used to advance an extension catheter through the pre-existing tube and into the small bowel where its fixed in place with endoscopic clips.
This procedure is used for patients that cannot be fed into the stomach due to pancreatitis or gastric outlet obstruction and for patients who are at high risk for gastric reflux and aspiration.

PEJ - Percutaneous Endoscopic Jejunostomy

A PEJ procedure is technically similar to PEG placement, however the feeding tube is placed directly into the small intestine through the skin.
This procedure is technically challenging due to the small diameter of the small bowel and is therefore performed by experts in endoscopy.